School of Public Health, Fudan University, 138 Yixueyuan Road, Shanghai, 20032, China.
Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC, 27710, USA.
Infect Dis Poverty. 2021 Jun 29;10(1):92. doi: 10.1186/s40249-021-00875-8.
China has successfully reduced tuberculosis (TB) incidence rate over the past three decades, however, challenges remain in improving the quality of TB diagnosis and treatment. In this paper, we assess the effects of the implementation of "China National Health Commission (NHC) and Gates Foundation TB Prevention and Control Project" on the quality of TB care in the three provinces.
We conducted the baseline study in 2016 and the final evaluations in 2019 in the 12 selected project counties. We obtained TB patients' information from the TB Information Management System and reviewed medical records of TB cases in the TB designated hospitals. We compared TB diagnosis and treatment services with the national practice guideline and used Student's t-test and Pearson χ tests or Fisher's exact tests to compare the difference before and after the project implementation.
The percentage of sputum smear-negative (SS-) patients taking culture or rapid molecular test (RMT) doubled between 2015 and 2018 (from 35% to 87%), and the percentage of bacteriologically confirmed pulmonary TB cases increased from 36% to 52%. RMT has been widely used and contributed an additional 20% of bacteriologically confirmed TB cases in 2018. The percentage of TB patients taking drug susceptibility tests (DST) also doubled (from 40% in 2015 to 82% in 2018), and the proportion of TB patients receiving adequate diagnosis services increased from 85% to 96%. Among all SS- TB patients, over 86% received the recommended diagnostic services at the end of the study period, an improvement from 75% prior to the project implementation. However, the proportion of TB patients treated irrationally using second-line anti-TB drugs (SLDs) increased from 12.6% in 2015 to 19.9% in 2018. The regional disparities remained within the project provinces, albeit the gaps between them narrowed down for almost all indicators.
The quality of TB diagnosis services has been improved substantially, which is attributable to the coverage of new diagnosis technology. However, irrational use of SLDs remains a concern after the project implementation.
在过去的三十年中，中国成功降低了结核病（TB）的发病率，但在提高 TB 诊断和治疗质量方面仍面临挑战。本文评估了在三个省份实施“中国国家卫生健康委员会（NHC）和盖茨基金会结核病防治项目”对 TB 护理质量的影响。
我们于 2016 年进行了基线研究，于 2019 年进行了最终评估，研究对象为 12 个选定的项目县。我们从 TB 信息管理系统中获取 TB 患者信息，并审查了 TB 定点医院的 TB 病例病历。我们将 TB 诊断和治疗服务与国家实践指南进行了比较，并使用学生 t 检验、Pearson χ 检验或 Fisher 精确检验比较项目实施前后的差异。
2015 年至 2018 年期间，痰涂片阴性（SS-）患者接受培养或快速分子检测（RMT）的比例翻了一番（从 35%增至 87%），菌阳肺结核患者比例从 36%增至 52%。RMT 已广泛应用，并在 2018 年为菌阳 TB 患者增加了 20%。接受药物敏感性检测（DST）的 TB 患者比例也翻了一番（从 2015 年的 40%增至 2018 年的 82%），接受充分诊断服务的 TB 患者比例从 85%增至 96%。在所有 SS-TB 患者中，在研究期末，超过 86%的患者接受了推荐的诊断服务，这一比例高于项目实施前的 75%。然而，不合理使用二线抗结核药物（SLD）治疗的 TB 患者比例从 2015 年的 12.6%增至 2018 年的 19.9%。尽管项目省份之间的差距有所缩小，但区域差异仍然存在。
TB 诊断服务质量有了显著提高，这归因于新诊断技术的普及。然而，项目实施后，SLD 的不合理使用仍然令人担忧。
